One of the most interesting news stories you probably did not see last week was the sentencing of ophthalmologist Dr. Salomon Melgren to 17 years in a federal slammer for health care fraud.

Melgren’s name may not ring a bell but he is (or was) best buds with U.S. Sen. Robert Menendez, D-N.J., and they were tried together in New Jersey federal court on bribery and corruption charges last year.

That trial ended in a mistrial, the federal judge in charge of the case then dismissed seven charges and prosecutors, feeling the heart had been cut out of their case, dropped the remaining 11 counts.

Menendez went back to his Senate seat and committee chairmanships none the worse for the experience.

Advertisement

But Melgren faced a very different fate. He was shipped back in his prison scrubs to the Southern District of Florida where he had been tried and convicted last April on 67 counts of fraudulent billing.

Over the course of several years he diagnosed almost all his Medicare patients with age-related macular degeneration and, in fact, had his staff pre-fill the same diagnosis on virtually every patient chart before he even saw them.

Either the patients did not have ARMD, or they had dry ARMD, which cannot be treated, but he claimed they had wet ARMD, which he treated with the expensive drug Lucentis.

Melgren split single-dose vials of Lucentis into four doses, which he administered to patients, and then charged Medicare for all four doses, according to prosecutors.

Things got hairy for him when Medicare refused to pay $8.9 million for the divided doses and he twice sent his pal, the senator, to meet with top officials of the Department of Health and Human Services to intervene on his behalf.

The officials told Menendez no, they would not pay for the same vial of Lucentis more than once.

And then the DOJ got interested in Melgren’s other billing practices, leading to his conviction on the health care fraud counts.

So Melgren, 63, was sentenced to 204 months, or 17 years, in federal prison and, preliminarily, to forfeit $42.5 million.

In the last year, several doctors have been convicted of health care fraud charges and have received long sentences and orders to pay millions in restitution to Medicare and private insurers.

A Detroit neurosurgeon got 19 years last year for performing spinal fusion surgeries using hardware he never actually installed.

A jury convicted an Ashland, Ky., cardiologist of performing and billing $1 billion in seven years for unnecessary stent procedures, but a judge acquitted him ruling that they were judgment calls. The DOJ is appealing.

On Feb. 7, a New York surgeon was sentenced to 13 years in prison and $7.2 million in restitution for billing Medicare for 2,000 procedures he claimed he performed on just 16 patients.

And that cancer doctor you saw on “60 Minutes,” Farid Fata, who diagnosed hundreds of healthy patients with cancer and then treated them with toxic chemotherapy so he could game insurance companies?

He got 45 years in prison and was ordered to pay $17 million in restitution, much of it going to the patients.

I want to emphasize that only a very small handful of doctors try cheat on their billings or engage in outright criminal enterprises like pill mills

Under the Obama administration and continuing to date under President Trump, the DOJ has been doggedly chasing these cheats and expects to recover about $4 billion from them this fiscal year.

Some people set up home health care agencies that don’t actually provide much, or any, health care to convalescents.

Others run “sober homes” or “three-quarters” homes, rooming houses for parolees and addicts, and take illegal kickbacks for sending their residents to treatment facilities that again, don’t provide much or any treatment.

The most lucrative new scam is to recruit patients to seek unnecessary prescriptions for custom-made “compounded medications,” from their doctors.

The patients’ health plan administrators are forced to reimburse thousands of dollars for each preparation and most of that money gets kicked back to the compounding pharmacies, doctors, patients and recruiters.

In New Jersey, 14 people scamming a state public employee health plan recently pleaded guilty in a $50 million compounded medicine scam, including a fireman and a high school guidance counselor.

The most draconian sentences for health care fraud ever handed down were to Ebong Tilong, 53, and his wife Maria Neba, 53, operators of home health care agencies in Texas.

Last September, Neba, the Cameroon-born mother of 7-year-old twins, was sentenced to 75 years in prison – in accordance with federal sentencing guidelines – even though she is suffering from Stage IV breast cancer.

Tilong then fled the country and was sentenced in January to 80 years in absentia. Their children are now in foster care.

The federal courts and the Department of Justice have been sending a strong message to health care fraud scammers and opioid dealers in white coats — there’s a prison cell at the end of that road.

I’m think medical professionals are aware of that message, but I’m not sure how much the rest of us are, so I am doing my part here to at least tell you about some of the worst ones.

As patients, you can do your part to catch these crooks who are robbing us blind of the Medicare or other insurance money we have paid for all our working lives and who are sometimes putting our lives in danger to do it.

Check your Medicaid, Medicare or insurance company’s “This is Not a Bill” statements to make sure that you have really received the care your doctors or other providers have billed for and report the cheaters.

This is one way we can make sure Medicare is there for us, not for the Melgrens of the world.

Jodine Mayberry is a retired editor, longtime journalist and Delaware County resident. Her column appears every Friday. You can reach her at jodinemayberry@comcast.net.